Effect community mental health nursing
By analysing routine data, we investigate the effect of community mental health nursing (CMHN) on the psychiatric hospitalisation of people with mental illness.
Factsheet
- Schools involved School of Health Professions
- Institute(s) Nursing
- Research unit(s) Innovation in the Field of Mental Health and Psychiatric Care
- Strategic thematic field Thematic field "Caring Society"
- Funding organisation BFH
- Duration (planned) 01.02.2024 - 28.02.2025
- Head of project Dr. Anna Hegedüs
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Project staff
Dr. Anna Hegedüs
Prof. Dr. Dirk Richter - Keywords psychiatric nursing, Spitex, community mental health care, effect, HomeCareData
Situation
Psychiatric nursing plays an important role in the context of outpatient care for people with mental illnesses. In Switzerland, this is mainly provided by home care organisations (Spitex), outpatient clinics and freelance psychiatric nurses. If community mental health nursing is prescribed by a doctor, the home care organisations carry out a needs assessment. This is usually done using the interRAI Community Mental Health tool launched by Spitex Schweiz in 2020. The analysis of routine data, such as that from the interRAI-CMH needs assessment tool and psychiatric hospitalisations, which are recorded in the medical statistics of hospitals, allows to examine the effectiveness of interventions. The potential of such analyses has not yet been fully exploited. The present study aimed to contribute to the evidence base on CMHN by a) evaluating the effect of admission to CMHN services on psychiatric hospitalisation among people with mental disorders, and b) identifying risk factors associated with psychiatric hospitalisations during the course of CMHN care.
Course of action
We conducted a naturalistic observational study using data from two linked national databases: the HomeCareData register and the Medical Statistics of hospitals. The study included adults who were admitted to CMHN services between January 2020 and December 2022 and whose data was documented in HomeCareData. With mirror-image methods we compared psychiatric hospitalisation rates in equally long pre-index and post-index periods, defined by each individual’s duration of CMHN care, with each participant serving as their own control. The start of CMHN care was defined as the index date. For a sensitivity analysis individuals hospitalized within 60 days before start of CMHN were excluded to address potential regression to the mean effects. Uni- and multivariable logistic regression were used to identify risk factors of hospitalisation during CMHN care.
Result
The study included 5,252 adults cared for by CMHN between 2020 and 2022. The clients were, on average, 52 years old; 66% were female, and 53% lived alone. Effect of psychiatric Spitex on hospitalisations: Primary mirror-image analysis revealed a significant reduction in psychiatric hospitalisations following the commencement of psychiatric Spitex services (IRR 0.60). The risk was reduced by 40%. However, when the group hospitalised within 60 days before the start of CMHN was excluded (sensitivity analysis), this effect disappeared (IRR 0.97). This suggests that the observed decline in the main analysis could be partly explained by regression to the mean – i.e. a natural stabilisation following an acute crisis. Risk factors during CMHN: The analysis shows that previous psychiatric hospitalisations and previous involuntary admissions increase the risk of hospitalisation during CMHN.
Looking ahead
This study is the first nationwide investigation to use routine data to analyse the effect of CMHN on hospitalisation rates. The results show a decline in hospitalisations after the start of CMHN support. However, the lack of effect in the sensitivity analysis suggests that this decline cannot be solely attributed to CMHN. This study demonstrates that routine data is a valuable tool for evaluating real-world care services. Nevertheless, it also illustrates the challenges of measuring effects without a comparison group. To be able to examine the effect of psychiatric Spitex even more precisely in the future, broader data coverage, uniform documentation and further research are needed.
